This document discusses several cases where conditions were either congenital or acquired later in infancy. It provides evidence that hip dislocations and cryptorchidism can develop later than birth, highlighting the importance of periodic examinations. Regular checks of the hips, scrotum, and heart are recommended throughout childhood to detect issues even in previously healthy children, as a heart murmur was found in one case three years later. The document emphasizes that conditions initially thought to be congenital may actually be acquired later in development.

1. Congenital or acquired?
This is the question?
Lasmar Dahmani,MD

2. Heart murmur cryptorchidism
Hip dislocation

3. Hip dislocation
Female baby..normal delivery..no risk factors physical exam: hip both
stable
4 months old:pelvic Xray:hip:WNL
12 months old:right hip dislocation confirmed by new pelvic Xray
A recent report of five infants who had normal or
borderline
ultrasound imaging at two to six weeks and were later
found
to have dislocation in seven hips provides further
evidence
that an apparently normal hip may dislocate later in
infancy
Ref: J Pediatr Orthop. 2007;27:32–36

4. The AAP Guidelines recommend examination at birth
and at 1, 2, 4, 6, 9, and 12 months of age to allow
detection of DDH at an age when conservative
treatment is effective. "Late
developmental dislocation" is a more accurate
description than "missed dislocation" when an older
infant who had appropriate periodic
examinations presents with a dislocated hip.
Ref:http://aapgrandrounds.aappublications.org/content/18/1/8.1

5. Acquired cryptorchidism..mythe or fact?
Male baby..previously healthy..
Both testis palpable in scrotum at birth
During one year seen by many pediaticians
One year old :Cryptorchidism..was diagnosed..left testis..in the inguinal canal.(US
report)
It’s the fact..confirmed by many others
Ascensus testis occurred in 0.2%, 0.6% and 0.6% of boys at 3, 18 and 36
months of age respectively. When including recurrent cryptorchidism the
prevalence was 0.2%, 1.2% and 0.8% respectively. Ascensus testis accounts
for 58% of all cases of cryptorchidism (congenital and acquired) at 18
months, 71% at 36 months and thereafter 69%. Ascensus testis accounts
for more than half of cryptorchid testes seen in childhood and occurs in
both previously scrotal and cryptorchid testes. We therefore recommend
that all boys should have testis position checked regularly during
childhood, at least up to 3 years of age
Int J Androl. 2009 Aug;32(4):423-8.

6. Heart murmur ..congenital missed or acquired ?
Male child..previously healthy..with normal cardiovascular exam at 15
months old..
Three years after referred by school doctor for heart murmur
No history of rheumatic fever or infective endocarditis..
Cardiologist report: Still’s heart murmur
Still’s murmur:
Due to blood flow across the aortic valve. Heard best over the
right upper sternal border. It is a
systolic ejection murmur, vibratory, musical in quality. Seen
in infancy to adolescence
Ref: http://www.aafp.org/afp/990800ap/990800f.html

7. Key messages
Routinely exam of hip,scrotum
and heart should be
performed at many times even
in previously healthy child